Heart Failure (Exam 2) Flashcards
Blood flow through the heart
Superior and Inferior Vena Cave
Right atrium
Tricuspid valve
Right ventricle
Pulmonary valve
Pulmonary artery
Lungs
Pulmonary vein
Left atrium
Left ventricle
Aorta
Rest of body
4 things that cause heart failure
Issues with
-Preload
-Afterload
-Myocardial contractility
-Heart rate
Preload
Amount of blood in the heart during diastole
Increase blood volume in the heart =
increase preload
Afterload
The amount of resistance the ventricle has to overcome to get blood out of the heart
elevated = harder for the blood to get out
If someone has blood pressure then they typically have
Increase afterload
Which can lead to heart failure
Myocardial contractility
Someone might have a weakened myocardial contractility due to damage of myocardium from an MI
Ejection Fraction
Amount of the blood ejected from the ventricle (stroke volume)
divided by
Amount of blood in the ventricle prior to ejection (end-diastolic volume)
Normal Ejection Fraction
55-70%
Patients with heart failure have an ejection fraction of
40% or lower
Types of Heart Failure
Left sided heart failure
Right sided heart failure
Left-Sided Heart Failure
Blood backs up in left atrium / pulmonary veins
Left Sided Heart failure: Manifestations
Pulmonary congestion/edema (crackles - rhonchi - dyspnea)
Right sided heart failure
Blood backs up into the right atrium/venous circulation
Right Sided Heart Failure: Manifestations
JVD
Hepatomegaly
Ascites
Vascular congestion GI tract (loss of appetite)
Peripheral edema
Scrotal edema
Left Sided Heart Failure Signs and Symptoms
Paroxysmal Nocturnal Dyspnea (wake up from not catching breath)
Pulmonary congestion
Restlessness
Confusion
Orthopnea
Tachycardia
Exertional Dyspnea
Fatigue
Cyanosis
Right Sides Heart Failure Signs and Symptoms
Fatigue
Increase peripheral venous pressure
Ascites
Enlarged liver and spleen
HVD
Anorexia
Swelling in hands and fingers
Dependent edema
cor pulmonale
Refers to the enlargement of the right side of heart as result of pulmonary hypertension (COPD)
Right sided failure that results from left sided failure is NOT the same as cor pulmonale
Chronic Heart Failure
Typically diagnosed in outpatient setting
Marked by periods of acutely and or slowly worsening cardiac function
Often consequence of damage caused by other cardia events or diseases
Acute decompensated heart failure (ADHF)
Typically diagnosed in inpatient setting
Worsening chronic health failure s/s requiring urgent therapy
Life threatening condition requiring acute interventions
How does ADHF typically present?
Patient comes into the hospital because they can not catch their breath (SOA)
This is due to fluid caused by cardiac overload
How do we diagnose heart failure
History and physical exam
EKG
BNP and ProBNP
CXR (cardiomegaly and pleural effusions)
Echocardiogram (including EF)
LVAD
Heart transplant
BNP and ProBNP
Help distinguish HF from other sources of dyspnea
Most dyspneic patient with HF have BNP that is
> 400
Chronic Heart Failure: Collaborative Therapy
Treatment of underlying cause
Oxygen therapy at 2-6L/min per NC
Rest-activity periods (conserve energy)
Daily weights
Sodium-restricted diet
Chronic Heart Failure: Drug Therapy
ACE inhibitors (pril)
ARBS (artan)
Beta Blocker (olol)
Diuretics
Nitrates
Cardiac glycosides (Digoxin)
Cardiac Glycoside for Chronic Heart Failure
Digoxin
-Second line drug r/t risk for dysrhythmias (but classic drug still on the market)
Digoxin is a
Negative chronotropic (drug that slows down heart rate)
Postive inotropic (increase contractility)
Enhances cardiac output
What is the main concern with digoxin
Digitoxicity is concern
Hypokalemia aggravates digitoxicity
What aggravates digitoxcitiy
Hypokalemia
Digoxin levels should be
0.5-2 ng/ml
Mineralocorticoid Receptor Antagonist
Spironolactone
Potassium retaining diuretic
How does spironolactone help in chronic heart failure?
It supressess sodium/water retention to help with offloading of the left ventricle
Associated with decrease hospitalizations and cardiac death
Nursing Implication when giving digoxin
Monitor serum potassium
Digitalis + Hypokalemia =
-Digitalis toxicity
-Cardiac dysfunction
-Dysrhythmias
S/S of digitalis toxicity
Bradycardia
Headache
Dizziness
Confusion
Nausea
Visual disturbances (see halo around lights)
Before giving digoxin the nurse should
Take apical pulse for a full minute prior to administering
Hold if pulse below 60
Monitor cardiac rhythm
What is the antidote for digitalis toxicity
Digoxin immune Fab (given IV)
Digibind
Left ventricular Assist Device
LVAD
Used as a bridge transplant or destination therapy
BP cannot be read on these patients because machines are in continuous flow
S1/S2 cannot be heard
If patient with LVAD becomes unresponsive
DO NOT start CPR unless you are sure the pump is completely turned off
ADHF: Collaborative Therapy
Treat underlying cause
VS - Urine output hourly
EKG and pulse oximetry (continuous)
Monitor ABG results
High Fowleys w/ feet horizontal or dangling at BS
O2 mask of BiPap
Daily weights
Hemodynamic monitoring
ADHF Drug Therapy Goal
Decrease intravascular volume
Decrease afterload
Increase left ventricular function
Decrease anxiety
Drug Therapy for ADHF
-Diuretics
-Vasodilators
-Morphine
-Postive inotropes
